Anne L Gordon1,2,3, Vicki Anderson1,4,5,6, Michael Ditchfield7,8, Lee Coleman1,5,9, Mark T Mackay1,5,10, Mardee Greenham1,4, Rod W Hunt1,5,11, Paul Monagle1,5,12. 1. Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia. 2. Pediatric Neuroscience Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK. 3. Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK. 4. Department of Psychology, Royal Children's Hospital, Melbourne, Vic, Australia. 5. Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia. 6. School of Psychological Science, University of Melbourne, Melbourne, Vic, Australia. 7. Department of Diagnostic Imaging, Monash Medical Centre, Southern Health, Melbourne, Vic, Australia. 8. Department of Paediatrics, Monash University, Melbourne, Vic, Australia. 9. Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Vic, Australia. 10. Department of Neurology, The Royal Children's Hospital, Melbourne, Vic, Australia. 11. Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Vic, Australia. 12. Department of Haematology, The Royal Children's Hospital, Melbourne, Vic, Australia.
Abstract
BACKGROUND: Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period. AIMS: To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke across health domains, and explore the relationship between lesion characteristics and early outcome with six-month adaptive behavior. METHODS: A single center prospective longitudinal study at a tertiary level children's hospital. Recruitment was undertaken from December 2007 to January 2012. Participants were children aged birth to 18 years presenting acutely with first diagnosed arterial ischemic stroke. Lesion characteristics on brain imaging were classified. Children were grouped according to age at diagnosis for analysis (neonates vs. those aged >30 days). RESULTS: In 50 children with a median age of 47 months at diagnosis, sensorimotor impairments were most evident upon neurological examination acutely, especially in the older children. At both one-month and six-months motor functioning was significantly impaired in the older age group but no significant cognitive or language sequelae were identified. Lesion characteristics alone were not associated with six-month adaptive behavior outcomes. CONCLUSIONS: For patients surviving arterial ischemic stroke, the most significant clinical consequences both acutely and at six-months, are sensorimotor impairments, particularly evident in the older children. In contrast cognitive or language sequelae were not identified. Long-term surveillance is required to describe clinical course and rehabilitation needs, particularly for neonates and infants.
BACKGROUND:Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period. AIMS: To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke across health domains, and explore the relationship between lesion characteristics and early outcome with six-month adaptive behavior. METHODS: A single center prospective longitudinal study at a tertiary level children's hospital. Recruitment was undertaken from December 2007 to January 2012. Participants were children aged birth to 18 years presenting acutely with first diagnosed arterial ischemic stroke. Lesion characteristics on brain imaging were classified. Children were grouped according to age at diagnosis for analysis (neonates vs. those aged >30 days). RESULTS: In 50 children with a median age of 47 months at diagnosis, sensorimotor impairments were most evident upon neurological examination acutely, especially in the older children. At both one-month and six-months motor functioning was significantly impaired in the older age group but no significant cognitive or language sequelae were identified. Lesion characteristics alone were not associated with six-month adaptive behavior outcomes. CONCLUSIONS: For patients surviving arterial ischemic stroke, the most significant clinical consequences both acutely and at six-months, are sensorimotor impairments, particularly evident in the older children. In contrast cognitive or language sequelae were not identified. Long-term surveillance is required to describe clinical course and rehabilitation needs, particularly for neonates and infants.
Authors: Bin Jiang; Nancy K Hills; Rob Forsyth; Lori C Jordan; Mahmoud Slim; Steven G Pavlakis; Neil Freidman; Nomazulu Dlamini; Osman Farooq; Ying Li; Guangming Zhu; Heather Fullerton; Max Wintermark; Warren D Lo Journal: Stroke Date: 2020-12-07 Impact factor: 7.914